Nurses have one of the highest incidences of work-related back injuries of any profession, and it's been suggested that nurses underreport their injuries.1 In 2002, the American Nurses Association recommended the elimination of patient lifting to help lower the rate of back-related nurse injuries.2

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Most efforts made during the last 30 years to reduce work-related musculoskeletal injuries were centered on body mechanics and lifting techniques.3 These efforts have consistently failed to reduce the risks associated with patient handling and movement.4-20 Recent studies have focused on the introduction of ergonomic-assistive devices in patient-handling programs, which have been shown to decrease physical job demands, resulting in a decrease in injury severity and lost work days.21-23

In 2007, the CNO and interested staff members at the Ohio State University Wexner Medical Center collaborated on an ergonomics initiative. During a bargaining window, ergonomics became a topic of discussion for contract negotiation. Because all parties involved agreed that an ergonomics initiative was important for the welfare of nurses at the bedside, an ergonomics workgroup was formed in July 2007.

No implementation without communication

Effective communication was identified as one of the major change agents in successful implementation of a safe patient-handling program.24 A partnership with the Communications and Marketing department was established early in the planning process to clearly and concisely communicate program goals throughout the organization. (See Table 1.) The approach to implementation was a combination of top-down transformational leadership with staff involvement and participation. This type of staff-level partnership has been shown to affect culture change initiatives through enhancing staff behaviors, attitudes, capability, and commitment.25 In keeping with researched transformational models of leadership, it was decided to encourage transparency of the program and initiate respectful communication that modeled collegiality and strong teamwork ideals.26

Table 1: Ergonomics program goals

Assessing unit needs

The initial equipment purchase was made in late 2009. Due to budgetary constraints, an approach was taken to utilize funds in the most productive manner possible. Data from the Safety and Quality department were examined to determine which units had the highest injury rates from patient handling. An assessment of each area was completed to determine which units had the greatest identified need and the highest staff and management support for the ergonomics program.

The end goal of the initial implementation was to maximize return on investment (ROI) by optimizing utility of equipment in high-risk areas. Considered costs included the actual injury, backfill for nursing staff on limited and restricted duty, and postinjury turnover costs associated with staff unable to return to work.

Unit champions for patient safety

Before the equipment was ordered, careful planning took place to optimize staff awareness and participation. The group identified that implementing this program would require a culture change within the organization. Emphasis was placed on altering staff perceptions from reluctance to use the new equipment to acceptance.

Ohio State's Wexner Medical Center decided to use a multidisciplinary, unit-based approach for implementation. Unit champions were identified as frontline change agents who would commit to model-desired behaviors by using the new equipment. The unit champions were charged with learning advanced equipment-use techniques so that they could effectively educate other staff members. A 4-hour training course was offered and support was given for assistance in training facilitation. Upon completion of unit champion training, the purchased equipment was deployed and staff training began.

Barrier busting

It was identified early in the planning process that resistance to this change would most definitely occur. Barriers included skepticism about successful implementation and assumptions that safe patient handling wasn't a priority and equipment use would create more work because it would be difficult to use and take time away from other patients.24 Research has shown that opposition to change should be embraced rather than ignored, so resistance was viewed as a way to produce better results through feedback.27

Some staff members who were opposed to this change in practice were asked to serve as unit champions. Including these individuals increased the opportunity for constructive feedback, positive change in implementation, and staff participation. Seeing staff members, who were originally opposed to this change, enthusiastically embracing the new equipment created eagerness among others to learn about it too. This lateral transfer of knowledge allowed for unit subculture barriers to be effectively addressed.

Maintaining modifications

Without continual reinforcement and communication regarding the importance of this initiative, there would likely have been a back slide into old patient-handling techniques. (See Figure 1.) To prevent back slide, further training was included in mandatory yearly education for all staff members. Nursing staff members were again taught the proper use and location of all available equipment and given the opportunity to ask questions and practice using the equipment. When staff members were observed not using available equipment, managers were asked to figure out why they refused. The purpose of this was to create a sense of accountability and receive feedback on barriers to use.28

Figure 1. Ergonomics program implementation

Several weeks after the initial training and equipment deployment, feedback sessions were held to help identify issues that the frontline unit champions experienced. Most staff members were receptive to learning about the equipment, but it was difficult for them to leave the patient-care setting to attend staff development programs away from their unit. It was also identified that staff felt the equipment was easy to use in a nonpatient-care setting with willing and healthy participants, but was more of a challenge in the patient-care setting with acutely ill and dependent individuals. This feedback was embraced by the ergonomics committee and was at the forefront for creating Ergonomics Week.

During Ergonomics Week, 72 hours of around-the-clock coverage was provided and teams were deployed with equipment to round on the different units throughout Ohio State's Wexner Medical Center. This was used as point-of-care teaching to demonstrate ease of equipment use, affording staff the opportunity to have support in troubleshooting the equipment during use in a real patient-care setting. Because teaching took place at the bedside, no one needed to leave their patients to attend staff development programs. This approach was overwhelmingly successful in engaging and reinforcing the desired behaviors associated with safe patient handling.

Growth and reinforcement

Ongoing communication, reinforcement, transparency, and educational opportunities will continue to encourage organizational change and enhance patient and staff safety at Ohio State's Wexner Medical Center. Educational opportunities will continue to be offered at the bedside, along with ongoing training and partnership with the unit champion group. As the safe patient-handling program continues to secure additional funding, the same approach will be utilized in deploying equipment to areas with the greatest need. Equipment use is consistently assessed; underutilized equipment is reallocated to other departments in need.

Internal data for staff injury and turnover rates with associated financial impact will be monitored to evaluate ROI. The political climate will be monitored based on legislative conditions for safe patient-handling programs so that the organization can stay on top of any requirements. Internal policies and procedures will be developed related to the use of equipment and a partnership with the Staff Education and Development department will be established to plan for continued equipment-related education during initial orientation of staff members.

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